Diagnosis Assignment Vignette #1:
A nine-year-old girl named Sybil has been in five different grade schools because of her behavior. Since the age of six, she has frequently initiated physical fights using broken bottles and bricks. In the past year, to the horror of her neighbors, Sybil stole several of their cats, doused them in gasoline and set them on fire. When asked why, she stated that she thought it was “funny” and that she likes “watching what they (the cats) do when they are on fire.” Most recently, she threatened to kill her second-grade teacher for preventing her from attending recess. Her family is no longer able to control her violent outbursts and has brought her to a psychiatric inpatient facility in a major urban area. This is Sybil’s third such hospitalization. Sybil was brought to the hospital by her paternal grandmother and her father, who is wheelchair-bound. He has been in and out of jail for drug-related offenses since Sybil’s birth and is agitated throughout the interview. Sybil’s grandmother tells the story of Sybil’s life. At three months of age, she was removed from her mother’s custody because of neglect and has only seen her mother twice since then. She seemed to be doing OK until the age of six (records show she has a normal IQ and was doing well in school), but between the ages of six and seven she became increasingly aggressive and exhibited sexually inappropriate behavior. Sybil’s performance in school deteriorated rapidly, and she currently has domestic battery charges pending against her in court for hitting her cousin in the face with a brick.
1. What diagnoses are you considering for Sybil (list at least 2, and indicate which one seems more plausible)?
2. What other questions would you want to ask Sybil or other members of her family?
3. What are the clues in the story that led you to consider one diagnosis over another?
4. What additional information would you need to be confident about the diagnosis?
Vignette 2: Brian was a three-year old whose mother requested treatment to address his frequent aggression toward himself and others. She said that whenever she told him ‘no,’ he hit her and sometimes hit his head on the ground until she relented and gave him what he wanted. At the intake appointment, the therapist asked more questions about Brian. Although Brian smiled at the therapist when she came in, he then proceeded to play on his own and no longer maintained eye contact. His mother reported that his language had always been delayed, but she attributed this to the family speaking three different languages at home, and him learning pieces of each of them. During the interview Brian could not open a box so he brought it to his mother and put it in her lap to open, then went back to what he was doing once she opened it without saying anything to her or the therapist or looking at them. Mother reported that Brian often had difficulty with attention but could focus very well when engaged in something he liked to do. However, she said that it was difficult to get him to transition from one activity to another, and it was always a struggle to do routine tasks during the day, like getting dressed and brushing his teeth. 1. What diagnoses are you considering for Brian? 2. What other questions would you want to ask Brian’s mom? 3. What are the clues in the story that led you to consider one diagnosis over another? 4. What additional information would you need to be confident about the diagnosis? Vignette 3: Sofia is an 8-year-old who comes into treatment with her mother but does very little of the talking during the interview. Her mother describes that Sofia has a lot of difficulties with school, often reporting when she comes home that she has no friends, and that she does not want to go to school. At home, mother reports that she is a happy child until it comes time to go to school, at which point she becomes more reserved and sometimes lashes out in anger at other family members. When pressed for specific situations that are difficult, Sofia says that she does not know who to sit with at lunch or who to play with at recess. She says that math is her favorite subject because she is very good at it, although she said she does not like when the teacher calls on her in class because she worries that other kids will laugh at her if she gets the answer wrong. Socially, Sofia says that she has a best friend, but does not see her outside of school. She is not involved in any after school activities, although her mom has been encouraging her to choose one. She complains that she isn’t good at any of them and doesn’t like competition. 1. What diagnoses are you considering for Sofia? 2. What other questions would you want to ask Sofia’s mom? 3. What are the clues in the story that led you to consider one diagnosis over another? 4. What additional information would you need to be confident about the diagnosis? Vignette 4: Samuel is a ten-year-old boy whose parents bring to his pediatrician, describing academic concerns. They mention that his grades have been dropping since he started fourth grade, and his teachers are considering holding him back as a result. Additionally, his teachers have been reporting more behavioral concerns than in previous years, including being away from his desk when he is supposed to stay seated, and blurting out answers. Samuel says that school is boring and he would rather be playing, then tries to engage the pediatrician in a discussion about his favorite video game. Parents express frustration about trying to help him with homework at home, describing that this often leads to fighting and that each homework assignment takes longer than it should. Parents describe that sometimes Samuel gets lower grades on tests and assignments because he either just guesses at answers to get the assignment done, or hands in worksheets incomplete. They are wondering if he has a learning disability, so they would like to get an evaluation. What would you propose? 1. What diagnoses are you considering for Samuel? 2. What other questions would you want to ask Samuel and/or his teachers and parents? 3. What are the clues in the story that led you to consider one diagnosis over another? 4. What additional information would you need to be confident about the diagnosis? Vignette 5: Skyler is a 14-year-old female patient whose father attends the first meeting with her. He mentions that he has been concerned about her ever since they lost her mother 3 years prior. Since then, he said that she has been isolating herself in her room and has spent very little time with friends and stopped attending the extracurricular activities she had previously been so passionate about. When he tries to engage her in activities, Skyler reportedly yells at him to “leave her alone” or says that she’s not interested. Her grades have reportedly been suffering this year, as before she was a straight A student and now she has been getting Bs and Cs. Skyler reports that she is simply no longer interested in those activities she previously did, and that they don’t make her happy. She tears up when speaking with the therapist, and says that she often feels tired and sleeps a lot of the day (although her father reports that medical causes of fatigue have been ruled out). She says that since losing her mom she’s lost a lot of the hope she used to have for her future, so a lot of things like studying and homework just feel pointless. 1. What diagnoses are you considering for Skyler? 2. What other questions would you want to ask Skyler and her father? 3. What are the clues in the story that led you to consider one diagnosis over another? 4. What additional information would you need to be confident about the diagnosis?
Grid View
Excellent
Good
Fair
Poor
Main Posting
45 (45%) – 50 (50%)
Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources.
Supported by at least three current, credible sources.
Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.
40 (40%) – 44 (44%)
Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module.
At least 75% of post has exceptional depth and breadth.
Supported by at least three credible sources.
Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.
35 (35%) – 39 (39%)
Responds to some of the discussion question(s).
One or two criteria are not addressed or are superficially addressed.
Is somewhat lacking reflection and critical analysis and synthesis.
Somewhat represents knowledge gained from the course readings for the module.
Post is cited with two credible sources.
Written somewhat concisely; may contain more than two spelling or grammatical errors.
Contains some APA formatting errors.
0 (0%) – 34 (34%)
Does not respond to the discussion question(s) adequately.
Lacks depth or superficially addresses criteria.
Lacks reflection and critical analysis and synthesis.
Does not represent knowledge gained from the course readings for the module.
Contains only one or no credible sources.
Not written clearly or concisely.
Contains more than two spelling or grammatical errors.
Does not adhere to current APA manual writing rules and style.
Main Post: Timeliness
10 (10%) – 10 (10%)
Posts main post by day 3.
0 (0%) – 0 (0%)
0 (0%) – 0 (0%)
0 (0%) – 0 (0%)
Does not post by day 3.
First Response
17 (17%) – 18 (18%)
Response exhibits synthesis, critical thinking, and application to practice settings.
Responds fully to questions posed by faculty.
Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.
Demonstrates synthesis and understanding of learning objectives.
Communication is professional and respectful to colleagues.
Responses to faculty questions are fully answered, if posed.
Response is effectively written in standard, edited English.
15 (15%) – 16 (16%)
Response exhibits critical thinking and application to practice settings.
Communication is professional and respectful to colleagues.
Responses to faculty questions are answered, if posed.
Provides clear, concise opinions and ideas that are supported by two or more credible sources.
Response is effectively written in standard, edited English.
13 (13%) – 14 (14%)
Response is on topic and may have some depth.
Responses posted in the discussion may lack effective professional communication.
Responses to faculty questions are somewhat answered, if posed.
Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.
0 (0%) – 12 (12%)
Response may not be on topic and lacks depth.
Responses posted in the discussion lack effective professional communication.
Responses to faculty questions are missing.
No credible sources are cited.
Second Response
16 (16%) – 17 (17%)
Response exhibits synthesis, critical thinking, and application to practice settings.
Responds fully to questions posed by faculty.
Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.
Demonstrates synthesis and understanding of learning objectives.
Communication is professional and respectful to colleagues.
Responses to faculty questions are fully answered, if posed.
Response is effectively written in standard, edited English.
14 (14%) – 15 (15%)
Response exhibits critical thinking and application to practice settings.
Communication is professional and respectful to colleagues.
Responses to faculty questions are answered, if posed.
Provides clear, concise opinions and ideas that are supported by two or more credible sources.
Response is effectively written in standard, edited English.
12 (12%) – 13 (13%)
Response is on topic and may have some depth.
Responses posted in the discussion may lack effective professional communication.
Responses to faculty questions are somewhat answered, if posed.
Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.
0 (0%) – 11 (11%)
Response may not be on topic and lacks depth.
Responses posted in the discussion lack effective professional communication.
Responses to faculty questions are missing.
No credible sources are cited.
Participation
5 (5%) – 5 (5%)
Meets requirements for participation by posting on three different days.
0 (0%) – 0 (0%)
0 (0%) – 0 (0%)
0 (0%) – 0 (0%)
Does not meet requirements for participation by posting on 3 different days.
Total Points: 100
